ENGLISH ABSTRACT: A century of clinical observations and literature has repeatedly noted that trauma
responses occur in across a spectrum and on a continuum of severity. The existing, DSMIV
trauma response classifications include Acute Stress Disorder and PTSD as anxiety
disorders. Complex PTSD or DESNOS was considered as a proposed, alternative
classification during the DSM-IV PTSD Field Trials. It was not included as a separate
diagnosis, but briefly mentioned as an associated feature ofPTSD. Subsequent research
and replica studies have not proved conclusively whether Complex PTSD should be a
separate or associated feature ofPTSD, and the controversy continues to date.
Childhood traumatization is strongly associated with adult psychopathology, and
various Axis I and Axis II disorders, especially Borderline Personality Disorder, and to a
lesser extent, Antisocial Personality Disorder. Prolonged, repeated traumatization during
adulthood is also associated with subsequent Axis II pathology, including Borderline,
Obsessive-Compulsive and Avoidant Personality Disorders. Chronically traumatized
people with Axis II pathology often present with comorbid Axis I disorders including
Major Depression, PTSD, Substance Abuse, Somatization Disorder, and Dissociative
Disorders.
There are divergent views regarding the etiology of personality disorders in
chronically traumatized individuals. On the one hand, repeated, prolonged trauma could
cause enduring personality dysfunction in individuals despite normal premorbid
functioning. On the other hand, genetics, temperament, environmental factors and even a
pre-existing stress diathesis in the pre-trauma personality could contribute to the
development of post-trauma personality disorders. These two views do not necessary
contradict each other, but illustrate the complexity the human stress reaction.
Despite the controversy the inclusion of DESNOS into the diagnostic canon, it is
a valuable measure of predicting prognosis to existing treatment options. The present
main psychological treatment for post-traumatic stress disorders has been a cognitive-behavioral based, exposure intervention. Alternative therapies include psychodynamic
approaches, pastoral interventions and more recently, ecological and recovery based
models.
The Complex PTSD conceptualization contributes to a better understanding of the
personality structure of chronically traumatized people. There are three main areas of
disturbance. Firstly, a complex symptomatic presentation including somatization,
dissociation, and affect dysregulation. Secondly, deep characterological shifts including
deformations in concepts of relatedness and identity. Thirdly, and increased vulnerability
to harm, either self-inflicted or at the hands of others. The usefulness of integrating
these three concepts into the personality conceptualization of chronically traumatized
individuals is illustrated a case study.